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Purpose The purpose of this study was to describe factors associated with prolonged ventilatory support in subjects undergoing coronary artery bypass graft. Patients and Methods This was an analytical retrospective case–control study. Cases were defined as subjects requiring prolonged mechanical ventilation (>48 hours) following isolated coronary artery bypass graft. Subjects older than 18 years who had undergone surgery were included, while subjects with missing clinical record data, subjects in coma or subjects with prior cardiac surgery were excluded. Variables were measured at the three time points surrounding surgery. Results A total of 204 cases and 408 controls were included. The final logistic model showed an association between prolonged mechanical ventilation and the following presurgical variables: chronic obstructive pulmonary disease (OR 1.85; 95% CI: 1.06–3.23, p = 0.03) and chronic kidney disease (OR 1.90; 95% CI: −3.31; p = 0.02). The associated transurgical variable was the use of intra-aortic balloon pump (OR 3.63; 95% CI: 1.73–7.61, p = 0.00), and associated postsurgical variables were venous oxygen saturation <60% (OR 2.00; 95% CI: 1.18–3.40, p = 0.01), mediastinitis (OR 18.51; 95% CI: 4.06–84.40, p = 0.00), inotrope use (OR 2.82; 95% CI: 1.77–4.48, p = 0.00), pleural effusion requiring drainage (OR 3.57; 95% CI: 2.02–6.32, p = 0.00) and delirium (OR 3.45; 95% CI: 1.91–6.25, p = 0.00). Conclusion This study identifies factors associated with prolonged mechanical ventilation in subjects subject to coronary artery bypass graft over the presurgical, transurgical and postsurgical periods, identifying a new factor, delirium, for this type of population.

Introducción: el artículo reporta un caso clínico de intento suicida de un paciente con síndrome intermedio a causa de intoxicación por organofosforados. Para ello se analizó la historia clínica, los exámenes complementarios y el estudio electromiográfico, y se realizó revisión no sistemática de la literatura. Presentación del caso: se describe un caso diagnosticado en la unidad de cuidado intensivo, el cual presentó trastornos neuromotores, requerimiento de soporte ventilatorio con destete difícil y extubación fallida, así como el tratamiento médico y fisioterapéutico instaurado. Dentro del manejo de la intoxicación por organofosforados se incluye la descontaminación del tóxico, administración de atropina y pralidoxima, diagnóstico oportuno del síndrome intermedio y la prescripción de ejercicio terapéutico. El paciente recibió manejo interdisciplinario, logrando liberación de su condición crítica, pero con persistencia de debilidad muscular proximal; sin embargo, con el ejercicio alcanzó recuperación funcional de sus actividades básicas cotidianas. Conclusión: el panorama mundial de las intoxicaciones por sustancias químicas muestra que son causa de morbilidad y discapacidad importante. Los organofosforados son los plaguicidas más frecuentemente involucrados. Los síntomas y signos clínicos de este tipo de intoxicaciones se clasifican en manifestaciones colinérgicas, el síndrome intermedio y la neuropatía retardada.

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Introduction. Academic stress is a common problem among medical students that has a negative physiological, social, and learning impact. Perceived academic stress indicates how stressed a student is about academic issues over a given period of time and the ability to handle that stress. Objective. To determine the prevalence of PAS and evaluate possible risk factors, focusing on sex differences, burnout, emotional distress, academic-social support, and coping strategies. Method. A cross-sectional, retrospective, and comparative study was conducted through an online survey with medical students (MS) willing to participate anonymously. Results. All students reported PAS and the majority to a moderate-severe degree. Comparing the presence of abuse within the academic environment between men and women, we found differences in the frequency of reporting emotional abuse and sexual. Also, we found differences in perceived academic social support from teachers and family members. Multiple logistic regression analysis showed sex and current sexual abuse inside school had the strongest association with PAS in MS, followed by a family history of depression and perceived less academic social support from family. Discussion and conclusion. Timely identification of individuals at-risk will be critical to establish preventive strategies to limit the impact of PAS in MS, stress management programs, training coping skills, and offer prompt therapeutic alternatives when needed.